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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Burden of nonalcoholic fatty liver disease and advanced fibrosis in a Texas Hispanic community cohort
Jen-Jung Pan, Susan P Fisher-Hoch, Chaoru Chen, Ariel E Feldstein, Joseph B McCormick, Mohammad H Rahbar, Laura Beretta, Michael B Fallon
Jen-Jung Pan, Chaoru Chen, Michael B Fallon, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, the University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Susan P Fisher-Hoch, Joseph B McCormick, School of Public Health Brownsville Campus, the University of Texas Health Science Center at Houston, Brownsville, TX 78520, United States
Ariel E Feldstein, Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California at San Diego, San Diego, CA 92123, United States
Mohammad H Rahbar, Division of Clinical and Translational Sciences, Department of Internal Medicine, the University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Mohammad H Rahbar, Division of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX 77030, United States
Laura Beretta, Department of Molecular and Cellular Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Pan JJ contributed to study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, approved final submission; Fisher-Hoch SP contributed to study concept and design, acquisition of data, critical revision of the manuscript, approved final submission; Chen C contributed to interpretation of data, statistical analysis, approved final submission; Feldstein AE contributed to study concept and design, critical revision of the manuscript, approved final submission; McCormick JB contributed to study concept and design, acquisition of data, critical revision of the manuscript, approved final submission; Rahbar MH contributed to critical revision of the manuscript, statistical analysis, approved final submission; Beretta L contributed to critical revision of the manuscript, approved final submission; Fallon MB contributed to study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript, approved final submission.
Supported by MD000170 P20 funded from the National Institute on Minority Health and Health disparities (NIMHD); The Centers for Clinical and Translational Science Award 1U54RR023417-01 from the National Center for Research Resources (NCRR).
Ethics approval: The institutional review board of the University of Texas Health Science Center at Houston approved this study.
Clinical trial registration: None.
Informed consent: All involved persons gave their informed consent prior to study inclusion.
Conflict-of-interest: All authors have no conflicts of interest to declare.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding authors at jenjung.pan@uth.tmc.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jen-Jung Pan, MD, PhD, Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, the University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, United States.
jenjung.pan@uth.tmc.edu
Telephone: +1-713-5006677 Fax: +1-713-5006699
Received: February 8, 2015
Peer-review started: February 9, 2015
First decision: March 20, 2015
Revised: March 31, 2015
Accepted: April 16, 2015
Article in press: April 20, 2015
Published online: June 18, 2015
Processing time: 128 Days and 4.3 Hours
AIM: To investigate the potential burden of nonalcoholic steatohepatitis (NASH) and advanced fibrosis in a hispanic community.
METHODS: Four hundred and forty two participants with available ultrasonography data from the Cameron County Hispanic Cohort were included in this study. Each participant completed a comprehensive questionnaire regarding basic demographic information, medical history, medication use, and social and family history including alcohol use. Values of the nonalcoholic fatty liver disease fibrosis score (NFS), FIB4 index, BARD score, and Aspartate aminotransferase to Platelet Ratio Index (APRI) were computed using the blood samples collected within 6 mo of liver ultrasonography from each participant. Hepatic steatosis was determined by ultrasonography. As part of univariable analysis, for continuous variables, comparisons among groups were performed with student-t test, one way analysis of variance, and Mann-Whitney test. Pearson χ2 and the Fisher exact test are used to assess differences in categorical variables. For multivariable analyses, logistic regression analyses were performed to identify characteristics associated with hepatic steatosis. All reported P values are based two-sided tests, and a P value of less than 0.05 was considered to indicate statistical significance.
RESULTS: The mean age and body mass index (BMI) of the study participants were 49.1 years and 31.3 kg/m2, respectively. Among them, 65.6% were females, 52% had hepatic steatosis, 49.5% had metabolic syndrome, and 29% had elevated aminotransferases. Based on established cut-offs for diagnostic panels, between 17%-63% of the entire cohort was predicted to have NASH with indeterminate or advanced fibrosis. Participants with hepatic steatosis had significantly higher BMI (32.9 ± 5.6 kg/m2vs 29.6 ± 6.1 kg/m2, P < 0.001) and higher prevalence rates of elevation of ALT (42.2% vs 14.6%, P < 0.001), elevation of aspartate aminotransferase (38.7% vs 18.9%, P < 0.001), and metabolic syndrome (64.8% vs 33%, P < 0.001) than those without hepatic steatosis. The NFS scores (P = 0.002) and the APRI scores (P = 0.002) were significantly higher in those with steatosis but the scores of the FIB4 index and BARD were similar between the two groups. After adjusting for age, gender and BMI, elevated transaminases, metabolic syndrome and its components, intermediate NFS and APRI scores were associated hepatic steatosis in multivariable analysis.
CONCLUSION: The burden of NASH and advanced fibrosis in the Hispanic community in South Texas may be more substantial than predicted from referral clinic studies.
Core tip: Among different racial and ethnic populations in the United States, Hispanics (predominantly of Mexican origin) are at particular risk for nonalcoholic fatty liver disease (NAFLD) and appear to have a more aggressive disease course. From the risk stratification and early intervention perspective, it is pivotal to define the magnitude of the burden of NAFLD in asymptomatic individuals in Hispanic communities and identify the subset with nonalcoholic steatohepatitis (NASH). Such community based data are scarce. In this study, we assessed the potential burden of NASH and advanced fibrosis in a Hispanic community utilizing four common diagnostic panels and ultrasonography.
